1
Cornelis J.H. van de Velde, MD, PhD,FRCPS(hon)FACS(hon) Professor of Surgery President ECCO - the European Cancer Organization Past-President European Society of Surgical Oncology Leiden University Medical Center Leiden, The Netherlands How important is experience/volume in gastric cancer surgery?

2
Pean and Billroth Surgery for gastric cancer

3
Importance of training and team effort Surgical oncology is top-class sport Training and (multidisciplinary) team effort essential

16
Conclusion Urgent need for improvement of gastric cancer care in the Netherlands Centralization Auditing Use of multi-modality treatment

17
Centralization: volume-outcome relation US Birkmeyer et al, NEJM 2002 “Patients can often improve their chances of survival substantially, even at high volume hospitals, by selecting surgeons who perform the operations frequently”

18
Centralization: volume-outcome relation US Finks et al, NEJM years after initial US paper Decrease in postoperative mortality Esophagectomy: completely due to centralization

28
Conclusion Outcome-based referral provides a method for centralization by selecting hospitals with the best outcomes

29
Auditing Definition “providers of care are monitored and their performance is benchmarked against their peers” Surgical Hawthorne effect Gastric cancer audits currently performed in several European Countries United Kingdom Denmark Sweden Netherlands

38
Conclusions Participating countries: Considerable variation in hospital volumes and 30-day mortality Significant relation between volume and 30-day mortality But not the only explanation for differences between countries Limitations of this pilot study: Differences between used datasets Comorbidity, TNM stage, multimodality therapy Need for a uniform European Upper GI Cancer Registry